Bernie Sanders raised the profile for a single-payer health care system when he released an outline for his plan on January 17th. Sanders essentially advocates a “Medicare for All” plan. Rival Hillary Clinton criticized the plan not only for the timing of the release, 2 hours before their debate, but because the she said it is not realistic to pass in today’s political climate. Clinton noted that when the Affordable Care Act was being considered, the Democrats were not able to get a “single-payer option” passed in the healthcare reform bill. She also thinks it is ill-advised to consume the country and our politics in another healthcare reform debate. We have Obamacare, it’s better than what we had, and we can work to make it better.

So, pragmatism versus idealism. I have to admit, that although I support a universal coverage as a right of citizenship, Clinton makes a lot of sense. The politics, let alone the implementation of essentially replacing and entire industry (health insurance), are incredibly daunting. Not very realistic or practical.

The health insurance industry, like the overall health care industry, has experienced exponential growth. In 2014, there were an estimated 490,000 people employed in the health insurance industry. In 1980, there were $141,000. Let’s put that into perspective. In 1980, there were 225 million people in the U.S. and in 2014, 320 million. So, during a time when the U.S. population increased by less than a third, the number of workers in health insurance increased 3.5 times!

One of the biggest arguments for a single-payer/Medicare for all system has been that it would be more cost efficient. I’m seeing things all over the map here, from Medicare being much more efficient, to the exact opposite. If the Sanders plan would wipe out an entire industry, it darn well better be replacing it with something far superior. Perhaps our goal can be to provide coverage for all, do it more efficiently, and do it through the insurance industry.